[The effect of characteristics of patient on satisfaction with medical care rendered by general practitioner and district therapist].

The patient satisfaction is one of the key criteria of quality of medical care and indicator of patient-oriented approach and factor determining competitiveness of medical organization. The purpose of the study - the comparative analysis of patient satisfaction with primary health care provided by general practitioner and district physician, taking into account their gender, age characteristics, frequency and goals of visiting polyclinic. Sociological study was carried out on the basis of out-patient medical organizations in Moscow, Kemerovo and Belgorod. The final analysis included 415 questionnaires of respondents aged 18 years and older. The patients with different rate and purposes of visiting medical institution are equally satisfied with medical care provided by general practitioner and district physician. The satisfaction with general practitioner may have gender characteristics. The satisfaction with district physician may have age characteristics. The satisfaction with both specialists may depend on health status of patient. The model of providing primary health care according to principle of general practitioner may be more universal, while according to principle of district physician more acceptable for elder patients. In order to increase satisfaction with primary health care for all categories of patients, it is necessary to consolidate best organizational approaches of both models.

[The rise of attractiveness of specialty "General Practice" for graduates of medical universities].

The choice of specialty by graduate of medical university can be promoted by particular social, demographic and personal characteristics. Purpose of the study is to investigate demographic, social and personal characteristics of students in residency on specialty "General Medical Practice" in the Russian Federation. The sociological, statistical and analytical methods are applied. The sampling for survey consisted of 81 respondents. The specialty "General Medical Practice" is chosen mainly by women residing in city, non-married and without children. They are not characterized by participation in public life and they are characterized by the presence of hobbies (hobbies). The choice is conditioned by multidisciplinary nature of medical care and scope of professional horizons. They are attracted by treatment work and are less interested in pedagogy and science. In perspective, 80% of female respondents are going to get another specialty. More than 70% of respondents plan to work in out-patient conditions and predominantly in state sector of health care. For women, main goals of further professional training are improvement in main and adjoining specialties and career promotion. And in educational program, internal diseases are of greatest interest. The preferred forms of training are internships and e-learning. The main direction of improving educational process is increasing of scope of practical training. The comparative analysis of study results with data of previous publications was implemented. The factors influencing commitment to specialty are revealed. The proposals increasing attractiveness of general medical practice for graduates of medical universities and keeping in specialty after residency are formulated.

[The influence of gender, age and length of service on educational preferences of general practitioners in Russia].

In conditions of active development of medical and pharmaceutical sciences and dynamically changing work environment the education of physician is to be both continuous and personalized. Purpose of the study. To investigate effect of gender, age and work experience on educational needs and on preferences of forms and methods of training in the system of continuing medical education of Russian general practitioners. The research bases were Chairs occupied with issues of personnel training for general medical practice in Moscow, Belgorod and Kemerovo. The sociological, statistical and analytical research methodologies were applied. The overall analysis covered 402 questionnaires for general practitioners. The sampling of respondents included 19.1% of men, 80.9% of women; 52.4% were aged 36-55 (60) years, 29.3% - 24-35 years and 18.3% - 56 (61) years and older; 45.0% had experience in general medical practice up to 2 years, 16.3% - 3-4 years, 27.0% - 5-6 years, 11.7% - 7 or more years. The results of comparative analysis of opinions of physicians of both genders and various age with different time of experience concerning level of significance for practice of various areas of competence within the framework of specialty and their preferences regarding organizational forms, training methods and its duration are presented. It is established that gender, age and length of service had no significant effect on the studied parameters. However, certain characteristics associated with these factors are identified. The further study of possible influence of other internal and external factors can contribute in the future into formulation of scientifically grounded approach to choosing personalized trajectory of education of general practitioner.

[The role of routine clinical examination in the selection of patients for screening of geriatric syndromes.]

The great complexity of complex geriatric assessment makes it relevant to search for methods that facilitate the selection of patients who really need it. The article presents the results of studying the possibility of using a routine clinical examination to select elderly cardiological patients with an increased risk of senile asthenia. The study involved 52 elderly patients with heart and vascular pathology. All of them underwent a generally accepted clinical and laboratory-instrumental examination, the results of which were compared with the data of the questionnaire «Age is not a hindrance¼. To identify the relationships between the parameters of clinical and geriatric status, analysis of variance and correlation analysis were used; summary frequency tables were built and analyzed. The significance threshold (p-value) was less than 5% (p<0,05). As a result of the study, it was found that the general condition of patients differing from satisfactory, complaints of shortness of breath, headaches, the presence of peripheral edema, lack of pulse on the dorsalis pedis arteries and posterior tibial arteries indicate an increased likelihood of senile asthenia in the subjects (p<0.05).

Meta-Analysis of Non-Alcoholic Fatty Liver Disease and Electromechanical Reconstruction of Myocardium.

In developed countries, non-alcoholic fatty liver disease (NAFLD), which results from obesity, has become endemic and kills many adults annually. Health research centers in most countries are looking to examine the relationship between metabolic syndrome (MetS) and metabolic biomarkers. A bleeding-prone standard liver biopsy or costly magnetic resonance imaging scan is used to diagnose NAFLD. The present study aimed to analyze medical databases using various scientific articles; moreover, this experiment analyzed medical databases using published scientific articles related to NAFLD, endovascular treatment, cardiac arrhythmias and conduction disorders, changes in the geometry of atria and ventricles, changes in myocardial mass volume as well as diastolic flow left and right ventricular systolic functions, coronary blood flow, analysis of the dependence of epicardial fat tissue (EFT) thickness, and the presence of chronic heart failure (CHF). It is demonstrated that the index of EFT in NAFLD positively correlated with the criteria of cardiovascular health, values of the carotid intima-media thickness, and calcification of the coronary arteries on the coronary artery calcium scale (P<0.0001). The index of per EFT significantly correlated with the factor of the age of the NAFLD patients (P=0.04), hemoglobin A1C level (P<0.001), systemic inflammatory index (P=0.02), the index of impaired glucose tolerance (P=0.03), and especially, the patient's diabetes factor (P<0.001). In addition, adiponectin levels were significantly lower in individuals with NAFLD (P=0.001) and patients with MetS (P=0.02). NAFLD in association with an increase in epicardial adipose tissue (EAT) is an independent risk factor for atherosclerosis, coronary heart disease, CHF, as well as structural and electrophysiological myocardial remodeling. The study of pathogenetic mechanisms in the context of the role of EAT and clinical monitoring of its condition are urgent problems of modern medicine.

[About attitude of graduates of medical specialties to job placement in primary health care and post-graduate training].

In order to study attitude of graduates of medical specialties to employment in primary health care system and to postgraduate medical education, anonymous survey was carried out on sampling of 188 graduates of medical institute of the Belgorod State National Research University in 2020-2021. The analysis established that married students more often than single ones seek permanent job with guaranteed salary and social protection. The advanced graduates easier get their future specialty than weak and satisfactory ones. The graduates-foreign citizens and stateless ones consider themselves under-prepared for medical practice as compared with graduates-residents of city and oblast. The youths more often than girls meet future employers. the weak graduates meet the employers less often than advanced graduates. The satisfactory graduates, as compared with weak and advanced graduates, more often have close relatives among medical workers. By the time they graduate, youths more often than girls get experience of practical medical activity. The advanced graduates also more frequently get practical medical experience than weak and satisfactory graduates.

[The experience of reforming primary health care in conditions of demographic trends of average population age increasing].

The article presents experience of reforming of primary health care in the Belgorod Oblast in 2016-2019. In the course of reforming the original organizational model of interaction between doctors and patients developed and implemented. The measures were applied to strengthen the material-technical base and personnel potential of primary medical care. The offices of General Practitioners were arranged within step accessibility for patients. The continuous training of family physicians was organized at the workplace. The unified regional medical information system was developed and implemented enabling corporate conference communication, remote consultations, population feedback and remote arrangement of making appointment with physician. The differentiated approach to medical personnel remuneration of labor was brought on the basis of key performance indices that permitted to increase their salary and quality of work. As a result of the reforms, the percentage of people covered by family physicians dispensary observation increased by 13%, number of emergency calls decreased by 3.3% and number of calls because of illness reduced by 17%. The mortality rate of people older than able-bodied age began to decrease and population life expectancy reached prognosticated numbers of 74 years in 2019.

[Vitamin D deficiency in elderly with arterial hypertension and left ventricular diastolic dysfunction.]

The aim of the study was to evaluate the relationship between serum vitamin D deficiency and the risk of diastolic dysfunction in elderly patients with arterial hypertension. The study included 162 elderly patients (mean age 65,4±5,2 years) with arterial hypertension. The first group consisted of 67 patients with hypertension without vitamin D deficiency, the second-95 patients with hypertension with deficiency. It was revealed that the patients with vitamin D deficiency in the blood serum were significantly older (Δ7,3%, p<0,05), had a higher body mass index (Δ9,6%, p<0,05), a shorter distance in the 6-minute walk test (Δ10,4%, p<0,05), and more often (72,6%) had left ventricular diastolic dysfunction (LV DD). Patients with hypertension with LV DD in the presence of vitamin D deficiency in serum had a worse metabolic profile - they had higher values of total cholesterol (Δ15,7%, p<0,05), triglycerides (Δ15,2%, p<0,05), the НOMA-IR index (Δ12%, p<0,05) and lower HDL values (Δ11,9%, p<0,05). In patients with hypertension with LV DD in the presence of vitamin D deficiency, the quality of life is lower than in patients with adequate levels of it. Conclusions. Elderly patients with hypertension had a slight difference in the incidence of LV DD between the study groups with different vitamin D status. However, elderly patients with hypertension with serum vitamin D deficiency had more pronounced disorders of LV diastolic dysfunction, lipid and carbohydrate metabolism. The quality of life according to the SF-36 questionnaire in elderly patients with hypertension with vitamin D deficiency in the blood serum was significantly lower than in the group with adequate vitamin D content.

[Age-related issues of the quality of life in patients with chronic heart failure middle range ejection fraction of elderly and senile age against the background of pharmacotherapy.]

The article deals with the issues of changing the quality of life of elderly and senile people with chronic heart failure with middle range ejection fraction (CHFmrHF) during long-term (12 months) pharmacotherapy. 377 patients were examined, including 129 people aged 45 to 59 years (middle age), 128 people aged 60 to 74 years (elderly), and 120 people aged over 75 years (senile age). The diagnosis was made in accordance with the Recommendations for the diagnosis and treatment of CHF (2013, 2016). The quality of life was assessed according to the MLHFQ questionnaire. There was an improvement in the quality of life after 12 months of therapy in all groups of patients, but the most pronounced results were obtained in old age. The maximum decrease in the level of anxiety was observed in men in the middle age group, in women - in the elderly. In the elderly and senile age, there was a comparable decrease in the scores on the Zung depression scale in both men and women.

Vitamin D Deficiency as an Independent Predictor of Myocardial Infarction in the Elderly.

Cardiovascular diseases are among the most common causes of disability and death in the world, and the number of patients with this category of diseases is increasing every year. This study aimed to investigate the role of vitamin D and the problems caused by its deficiency on the cardiovascular system. Level of D-(25(OH]D) in blood was studied by enzyme immunoassay in 95 elderly patients with myocardial infarction (MI) (the main group) and 92 elderly patients with no history of MI. The level of lipid metabolism as an indicator was determined using a KoneLab 300 auto-analyzer. Based on the results of this study, it was found that the elderly group without MI had the highest amount of D-(25(OH]D)(24.5±1.2), compared to the elderly group with MI (14.8±1.3). The rates of expressed deficiency, deficiency, and insufficiency in the group of elderly with MI were 53.6±5.1, 23.2±4.4, and 12.6±3.4%, respectively. This experiment has shown that D-(25(OH]D) is involved in lipid metabolism and reduces the accumulation of cholesterol by macrophages. The content of vitamin D in blood plasma was a prognostic predictor of MI, which improved MI in the elderly. Regardless of pathological changes, the deficit level of D-(25(OH]D) should be considered a laboratory predictor of MI in the elderly.

[The role of inflammation in the development of post-stroke depression in elderly patients.]

The aim of the study was to study the role of cytokines, the ratio of neutrophils and lymphocytes in the development of post-stroke depression in elderly patients. The study included 110 patients with acute ischemic stroke, including 60 middle-aged people (52±5 years) and 50 elderly people (66±4 years). The control group consisted of 20 middle-aged people without a history of stroke. After 3 months of follow-up, post-stroke depression (PSD) developed in the elderly in 28 patients (56%), in the middle age in 26 patients (43,3%). Patients with ischemic stroke in the elderly who developed PSD were significantly older (7,9%, p<0,05), more often had arterial hypertension (12,4%, p<0,05), the level of glucose was 16,1% higher (p<0,05), triglycerides by 14% (p<0,05), LDL-C by 12,8% (p<0,05). In middle age, patients with post-stroke depression had a body mass index higher by 8,1% (p<0,05), a glucose level by 9,6% (p<0,05), triglycerides by 10,9% (p<0,05), LDL-C by 9,7% (p<0,05) than patients without PSD. Elderly patients with ischemic stroke and PSD had higher levels of cytokines - IL-1ß was 35,4% higher (p<0,01), TNF-α by 27% (p<0,01), INF-γ by 18% (p<0,01) than in patients without PSD. In elderly patients with PSD, the ratio of neutrophils and lymphocytes (N/L) is 46% (p<0,001) higher than in patients without PSD. In the elderly, in the presence of PSD, the N/L ratio was 50% (p<0,001) higher than in the same middle-aged group. Thus, in elderly patients with ischemic stroke, the level of inflammatory markers may have a prognostic value in the development of post-stroke depression.

[Age-associated features of the development of fibrosis and inflamaging in patients with arterial hypertension and ischemic stroke.]

The article deals with the development of fibrosis and immune inflammation in patients with arterial hypertension and acute ischemic stroke in old age. The aim of the study was to study age-associated features of the concentration of fibrosis markers (metalloproteinase-9, tissue inhibitor of matrix metalloproteinases-1, their ratio MMP-9/TIMP-1), immune inflammation (TNF-α, IL-1ß, INF-γ) in patients with arterial hypertension and ischemic stroke (AI). The study included 86 patients with arterial hypertension (AH) of the 2nd degree, of which 42 were middle-aged (53±5 years) and 44 elderly (66±5 years). The control group consisted of 22 elderly patients with AH without a history of AI. The criteria for inclusion in the study are patients with hypertension who were admitted to the hospital in the acute period of the first cerebral stroke. It was found that in elderly patients with hypertension with AI, the indicators of inflamaging and fibrosis markers were significantly higher than in middle-aged people. The level of IL-1ß was 31,7% higher (p<0,01), TNF-α by 55,7% (p<0,001), INF-γ by 36,6% (p<0,01), the level of MMP-9 was 46,4% higher (p<0,01), TIMP-1 by 21,2% (p<0,01), MMP-9/TIMP-1 by 19,6% (p<0,01) in the elderly compared to middle-aged patients with hypertension and acute AI. Thus, it was found that patients with arterial hypertension and ischemic stroke have violations of the processes of inflamaging, synthesis and degradation of the extracellular matrix, especially pronounced in old age.

[The experience of reforming primary health care in conditions of increasing of population average age].

The article presents the experience of reforming primary health care in Belgorod Oblast in 2016-2019. In the process of reforming, the original organizational model of new interaction pattern "family doctor - patient - family members", was developed and implemented. The measures were taken to strengthen material-technical base and manpower potential of primary medical care. The general practitioners offices were positioned within "step accessibility" for patients. The continuous training of family doctors was organized at the workplace. The unified regional medical information system was developed and implemented enabling corporate conference communications, remote consultations, public feedback and remote arrangement of visits of patients to physician. The differentiated approach to remuneration of medical personnel was implemented using key performance indices that permitted to increase salaries and work quality. As a result of the reforms, the percentage of patients under supervision of family doctors increased up to 13%, the number of medical emergency calls decreased up to 3.3% and the number of calls because of illness decreased up to 17%. The mortality of population older than able-bodied age began to decrease and life expectancy reached relevant 74 years in 2019.

[The analysis of concomitant pathology in ophthalmologic practice based on electronic medical records data].

The study substantiates possibility of using data retrieved from electronic medical records (EMR) for analyzing comorbidity under diseases of the eye and its adnexa. The purpose of the study is to analyze prevalence and evaluate risk of development of comorbidity in patients with ophthalmologic pathology, based on the data presented in EMR. The total number of patients included into comprised 12 120 individuals. The 653 diagnoses were established and 122 703 requests for medical care were registered. The calculation was applied concerning prevalence, comorbidity index, relative risk of comorbidity. The study established prevalence and level of relative risk of development of opportunistic diseases characteristic for senile cataract and glaucoma. The obtained data on comorbidity may testify in-depth mechanisms of interaction of diseases at cellular, protein or genetic levels. The understanding of mechanisms of interaction of main and concomitant diseases can result in development of new methods of diagnostic, treatment and prevention of diseases. Thus, establishment of glaucoma diagnosis can induce physician to look for possible presence or high probability of development of prostate neoplasm that implies periodic control of prostate-specific antigen. The presented results demonstrate how EMR data can be used to identify, estimate prevalence and risk of comorbidity and also reveals pathogenic mechanisms of interaction between primary and recurrent diseases that can be applied in clinical practice.

[The role of stress factors and genetic predisposition in the development of stroke in patients with essential hypertension]. / Rol' stressovogo faktora v realizatsii geneticheskoi predraspolozhennosti k razvitiiu insul'ta na fone gipertonicheskoi bolezni.

To study the interaction of polymorphic markers of matrix metalloproteinases (MMP) and chronic stress in the development of stroke associated with hypertension. MATERIAL AND METHODS: A total of 830 patients, including 303 patients with ischemic stroke associated with essential hypertension (EH) and 527 patients with EH without stroke, were examined. The study of metalloproteinases SNP was carried out using real-time PCR. The functional significance and influence of polymorphic loci on gene expression was studied using of HaploReg (v4.1) (http://archive.broadinstitute.org) and GTEx-portal (http://www.gtexportal.org). RESULTS AND CONCLUSION: An association of the genotype GG (rs11568818) of MMP7 with a high risk of stroke in patients exposed to regular stress (OR=1.71) was observed. It was found that allele 5A and genotype 5A/5A (rs3025058) of MMP3 had a protective effect on the development of stroke in patients without regular stress in the anamnesis (OR=0.73 and OR=0.60, respectively). Those SNPs are localized in the region of histone proteins H3K4me1 and H3K4me3, in the region of hypersensitivity to DNase-1, in the region of binding of regulatory proteins and transcription factors. The polymorphic locus rs11568818 is associated with the expression level of MMP7.

[Immunoassay and discriminant analysis to improve the diagnosis of ovarian cancer in the elderly.]

Ovarian cancer is a common pathology in the structure of tumors among elderly women. The aim of the work is to identify the leading indicators of interleukin profile to improve the diagnosis of ovarian cancer in the elderly. Enzyme immunoassay studied serum levels of interleukins in 78 patients with ovarian cancer stage IIB-IIIB according to the classification of FIGO at the age of 65-70 years and 42 women of similar age without ovarian cancer at the time of the study and in history. The differentiation of the compared groups is carried out by means of discriminant method. The leading diagnostic interleukins for ovarian cancer in the elderly are IL-1α, IL-1ß, IL-8 and TNF-α. The constructed discriminant models allow to differentiate patients with ovarian cancer and control women with an accuracy of 93.2-93.8%. The use of enzyme immunoassay and discriminant analysis improve the diagnosis of ovarian cancer in the elderly.

The role of cytokine gene polymorphism in the formation of arterial hypertension associated with metabolic syndrome.

We investigated the association of polymorphisms of genes tumor necrosis factors and their receptors (-308G/A TNFa, +250A/G Lta, +36 A/G TNFR1, +1663 A/G TNFR2) with the predisposition to the development of essential hypertension (EH) and the features of its clinical course in patients with metabolic syndrome. It has been demonstrated that the molecular genetic marker +36G TNFR1 (OR=1,25) is involved in the formation EH in individuals with metabolic syndrome. The risk of stage III EH in patients with metabolic syndrome is enhanced by genetic variants -308GA TNFa (OR=2,72), -308A TNFa (OR=2,72), +250G Lta (OR=1,80), and combinations thereof -308A TNFa with +1663G TNFR2 (OR=3,85), +250G Lta with +36G TNFR1 (OR=3,85), +250G Lta with +1663G TNFR2 (OR=3,85) while protective properties are inherent in -308GG TNFa (OR=0,32), +250AA Lta (OR=0,45), -308G TNFa (OR=0,37), +250A Lta (OR=0,56) and a combination of genetic markers -308GG TNFa with +250A Lta (OR=0,31), -308G TNFa with +250AA Lta (OR=0,39), -308G TNFa with +250A Lta (OR=0,31).

Age-related features of Cytoflavin effectiveness during experimental myocardial ischemia.

Administration of Cytoflavin to young rats with experimental myocardial ischemia was followed by activation of mitochondrial enzymes and significant accumulation of ATP in the myocardium and blood plasma, but did not modulate the stability of cardiomyocyte membranes and signs of hypoxia. Cytoflavin increased the severity of metabolic disorders and depleted the energy reserves of cells in old rats with myocardial ischemia.

[Efficiency of mildronate in rats of different age with experimental-induced myocardial ischemia].

Under experimental myocardial ischemia in rats of 10 months treatment with mildronate resulted in essential changes in metabolism of cardiomyocites. This includes stimulation of aerobic and anaerobic ways of power supply of heart cells: activation of glycolysis, oxidative phosphorylation and oxidative pyruvate decarboxylation with restoration of adenosine triphosphate pool to intact rats level in myocardium, serum and erythrocytes with signs of stabilization of cardiomyocytes membranes and essential decrease of tissue hypoxia. Introduction of mildronate to old rats (24 months) with an experimental myocardium ischemia was accompanied by lesser expressed changes of metabolism: activation of glycolysis and oxidative pyruvate decarboxylation without stimulation of Crebs' cycle enzymes. This became sufficient for restoration of adenosine triphosphate pool in myocardium without change of its quantity in serum and erythrocytes with signs of stabilization of cardiomyocytes membranes and moderate reduction of tissue hypoxia degree.

[Efficiency of trimetazidine treatment of experimental ischemic heart disease in age aspect].

Introduction of trimetazidine to 10-month-aged rats with experimental ischemic heart disease leads to an increase in carbohydrate utilization with energy purposes in myocardium, which is manifested by increasing activity of glycolysis enzymes with decreasing lactate level in myocardium, increasing activity of pyruvate dehydrogenase and citrate synthase in mitochondrial cardiomyocytes, and increasing ATP content in myocardium. This is accompanied by signs of stabilization of cardiomyocyte membranes and reduction in the degree of tissue hypoxia. The efficiency of trimetazidine decreases with increasing age: in 24-month-aged rats, the direction of changes is retained, but they are less pronounced.